Nine-Day Hold on Medicare Payments

Nine-Day Hold on Medicare Payments

CMS has issued a Change Request (CR5047) to inform providers who bill Medicare contractors (carriers, fiscal intermediaries [FIs] and regional home health intermediaries [RHHIs]) for their services that a brief hold will be placed on Medicare payments for all claims (initial claims, adjustment claims and Medicare Secondary Payer claims) during the last 9 days of the federal fiscal year (September 22 through September 30, 2006). These payment delays are mandated by section 5203 of the Deficit Reduction Act (DRA) of 2005.

No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments. This policy only applies to claims subject to payment. It does not apply to full denials, no-pay claims, and other non-claim payments such as periodic interim payments, home health requests for anticipated payments, and cost report settlements. All claims held as a result of this one-time policy that would have otherwise been paid during this nine day period will be paid on October 2, 2006.

Furthermore, Medicare contractors will continue to apply the 14-day electronic claim payment floor and the 29-day paper claim payment floor. On a case-by-case basis, Medicare FIs, RHHIs or carriers can make adjustments after October 1, 2006 for explanatory circumstances raised by the provider. For example, adjustments may be made to not charge a provider interest on an overpayment for those days for which offsets could not be made due to the hold of payments required by this DRA provision.

Please note that payments will not be staggered and advance payments during this 9-day hold will not be allowed. Official instruction regarding payment delay has been issued to your local contractor. If you have any questions about the 9-day hold, please contact your local carrier, FI or RHHI.